,,ii  #aaf? ,,congress  #b;d ,session   
,s4 #cbgg  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,febru>y #ab1 #bjbj,mr4
 ,casey introduc$ ! foll[+ bill2 :i* 0  
read twice & ref]r$ to ! ,committee on  
,f9ance  ,a ,,bill  ,to am5d title ,,xix
 ( ! ,social ,security ,act to /r5g!n ! 
infra/ructure (1 access to1 & report+ ( 
,m$icaid home & community-bas$ s]vices1 
& = o!r purposes4  #a4 ,%ort title ,?is 
,act may be cit$ z ! ,,hcbs             
,infra/ructure ,improvem5t ,act4  #b4   
,f9d+s & purpose  7a7 ,f9d+s ,congress  
f9ds ! foll[+3 7#a7 ,/ates are          
prioritiz+ fund+ ( _! ,m$icaid programs 
= long-t]m s]vices & supports 7ref]r$ to
 9 ?is section z ,,ltss7 to (f] a wid]  
range ( options = home & community-bas$ 
s]vices 7ref]r$ to 9 ?is section z      
,,hcbs71 b gaps 9 ,,hcbs rema94  7#b7 ,9
 fiscal ye> #bjaf1 ,/ates 7 sp5d+ only  
#eg p]c5t ( _! total ,,ltss budgets on  
,,hcbs1 well %ort ( ! national goal (   
#fi p]c5t set by ! ,c5t]s = ,m$ic>e     
,m$icaid ,s]vices4  7#c7 ,9 #bjag1 m ?an

 #gjj1jjj p ) disabilities1 old] adults1
 & *ildr5 7 on wait+ li/s to receive    
,,hcbs ?r\gh exi/+ ,m$icaid wav]        
programs4  7#d7 ,accord+ to projections 
by ! ,bureau ( ! ,c5sus1 ! numb] (      
adults ov] age #fe w rea* #hd1jjj1jjj by
 mid-c5tury1 & ! population ( p #he &   
old] w be ne>ly #ae million by #bjdj4   
7#e7 ,abs5t /rategic plann+ & inve/m5t1 
,/ates w exp]i5ce great] difficulties z 
! ne$s ( old] adults increase dem&s on  
,/ate home & community-bas$ s]vices     
,,hcbs capacity4  7#f7 ,a "o-"t1 t>get$ 
inve/m5t to /r5g!n ,/ate capacity to    
build out ,m$icaid infra/ructure t      
supports multiple ,,hcbs programs &     
connects to o!r ,f$]al & ,/ate programs1
 includ+ ,m$ic>e & ! ,old] ,am]icans    
,act1 w improve ! quality ( heal? &     
daily liv+ = ! millions ( old] adults1 p
 ) disabilities & _! families4  7#g7    
,home & community-bas$ s]vices ,,hcbs   
play an outsiz$ role 9 address+ ! social
 det]m9ants ( heal? among old] adults & 
p ) disabilities1 :o require accessible 

h\s+ & accessible transportation &      
access to reliable p]sonal c>e to av]t  
co/ly m$ical crises4  7b7 ,purpose ,!   
purpose ( ?is ,act is to e/abli% to a   
"o-"t infra/ructure improvem5t          
initiative = ,/ates to /r5g!n _! ,,hcbs 
capacity 9 select$ t>get areas1 includ+ 
h\s+ & transportation1 work=ce1 &       
employm5t supports1 9 ord] to improve ! 
co/-effectiv5ess ( long-t]m s]vice &    
support 7,,ltss7 ,m$icaid programs &    
coord9ation ) o!r programs t provide    
supportive s]vices to old] adults & p ) 
disabilities4  #c4 ,m$icaid home &      
community-bas$ s]vices infra/ructure    
improvem5t ,title ,,xix ( ! ,social     
,security ,act 7#db ,u4,s4,c4 #acif et  
seq47 is am5d$ by add+ at ! end !       
foll[+3  #aidg4 ,home & community-bas$  
s]vices infra/ructure improvem5t  7a7   
,def9itions ,9 ?is section3 7#a7 ,direct
 support pr(essional ,! t]m direct      
support pr(essional means a p]son :o1 9 
ex*ange = comp5sation1 provides s]vices 
to a p]son ) a disability 7z def9$ 9    

section #c ( ! ,am]icans ,)             
,disabilities ,act ( #aiij7 t promote   
su* p]son's indep5d5ce1 includ+-- 7,a7  
s]vices t enhance indep5d5ce & community
 inclusion = su* p]son1 includ+ travel+ 
) su* p]son1 att5d+ & assi/+ su* p]sons 
:ile visit+ fri5ds & family1 %opp+1 or  
socializ+2  7,b7 s]vices su* z coa*+ &  
support+ su* p]son 9 communicat+ ne$s1  
a*iev+ self-expression1 pursu+ p]sonal  
goals1 liv+ indep5d5tly1 & p>ticipat+   
actively 9 employm5t or volunt>y roles 9
 ! community2  7,c7 s]vices su* z       
provid+ assi/ance ) activities ( daily  
liv+ 7su* z fe$+1 ba?+1 toilet+1 &      
ambulation7 & ) tasks su* z meal        
prep>ation1 %opp+1 light h\sekeep+1 &   
laundry2 or  7,d7 s]vices t support su* 
p]son at home1 "w1 s*ool1 *ur*1 or o!r  
community sett+s4  7#b7 ,eligible ,,hcbs
 exp5ditures ,! t]m eligible ,,hcbs     
exp5ditures means exp5ditures by an     
,,hcbs infra/ructure ,/ate on m$ical    
assi/ance = home & community-bas$       
s]vices t are provid$ "u ! ,/ate plan or

 waiv] dur+ ! ,/ate's ,,hcbs            
infra/ructure p]iod & :i* aim to        
collaborate ) o!r programs (f]+ support 
= home & community-bas$ s]vices4  7#c7  
,fir/ mile_/la/ mile transportation ,!  
t]m fir/ mile_/la/ mile transportation  
means ! transportation necess>y to--    
7,a7 transport a p]son to a fix$ r\te   
transit sy/em t ! p]son c\ld n o!rwise  
conv5i5tly access by walk+1 :eel*air1   
walk]1 or o!r self-propell$ mobility    
me?od2 &  7,b7 transport a p]son f a    
fix$ r\te transit sy/em to ! p]son's    
f9al de/9ation :5 ! f9al de/9ation is n 
)9 a di/ance t ! p]son c\ld conv5i5tly  
access by walk+1 :eel*air1 walk]1 or o!r
 self-propell$ mobility me?od4  7#d7    
,,hcbs infra/ructure p]iod ,! t]m ,,hcbs
 infra/ructure p]iod means1 ) respect to
 an ,,hcbs infra/ructure ,/ate1 !       
#g-;fiscal ye> p]iod t beg9s ) ! fir/   
fiscal ye> t beg9s aft] ! date on :i* ! 
,/ate is grant$ approval by ! ,secret>y 
"u subsection 7c7 to conduct an ,,hcbs  
infra/ructure program4  7#e7 ,,hcbs     

infra/ructure program ,! t]m ,,hcbs     
infra/ructure program means a           
demon/ration program conduct$ "u ?is    
section4  7#f7 ,,hcbs infra/ructure     
,/ate ,! t]m ,,hcbs infra/ructure ,/ate 
means a ,/ate t has be5 grant$ approval 
by ! ,secret>y "u subsection 7c7 to     
conduct an ,,hcbs infra/ructure program4
  7#g7 ,home & community-bas$ s]vices ,!
 t]m home & community-bas$ s]vices means
 long-t]m1 p]son-c5t]$ s]vices &        
supports t are n provid$ 9 an           
in/itutional sett+1 includ+-- 7,a7 a    
home & community-bas$ s]vice provid$ "u 
subsection 7c71 7d71 or 7i7 ( section   
#aiae or "u a waiv] "u section #aaae2   
7,b7 home & community-bas$ long-t]m     
s]vices & supports 7provid$ 9 accordance
 ) ! requirem5ts = home & community-bas$
 sett+s "u sections #dda4ecj & #dda4gaj 
( title #db1 ,code ( ,f$]al             
,regulations71 includ+-- 7i7 s]vices    
describ$ 9 p>agraphs 7#g71 7#h71 7#ac71 
7#ai71 & 7#bd7 ( section #aije7;a72     
7ii7 home & community-bas$ s]vices      

describ$ 9 subsection 7c77#d77;,b7 (    
section #aiae2  7iii7 self-direct$ home 
& community-bas$ s]vices describ$ 9     
subsection 7i7 ( section #aiae2  7iv7   
self-direct$ p]sonal assi/ance s]vices  
7z def9$ 9 subsection 7j77#d77;,a7 (    
section #aiae72 &  7v7 home &           
community-bas$ att5dant s]vices &       
supports describ$ 9 subsection 7k7 (    
section #aiae2  7,c7 a home heal? c>e   
s]vice2 &  7,d7 a p]sonal c>e s]vice4   
7#h7 ,long-t]m s]vices & supports ,! t]m
 long-t]m s]vices & supports has ! mean+
 giv5 t t]m 9 section #dch4b ( title    
#db1 ,code ( ,f$]al ,regulations 7z ( ! 
date ( enactm5t ( ?is section74  7#i7   
,%>$ liv+ ,! t]m %>$ liv+ means a liv+  
arrangem5t involv+-- 7,a7 n m ?an #b p )
 disabilities or an old] adult ) a      
disability1 except if #a or m ( ! p are 
relat$ to ea* o!r 7by blood or a close  
association t is equival5t to a family  
relation%ip72  7,b7 a p]son :o-- 7i7    
provides long-t]m s]vices & supports 9  
ex*ange = comp5sation2  7ii7 lives      

toge!r 9 a private home ) ! recipi5t (  
su* s]vices2 &  7iii7 receives a /ip5d  
or room & bo>d z ! prim>y =m ( paym5t = 
provid+ su* s]vices2  7,c7 a p]son      
receiv+ fund+ ?r\gh a ,/ate ,m$icaid    
program "u ?is title or ano!r publically
 fund$ program2 &  7,d7 ! p]son receiv+ 
su* s]vices hav+ ! f9al decision reg>d+ 
:o is ! provid] ( su* s]vices liv+ ) !  
p]son1 ?r\gh a consum]-driv5 mat*+      
process t includes relation%ip build+1  
p]son-c5t]$ plann+ z def9$ by !         
,adm9i/rator ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices1 & an assessm5t (     
individual compatibility4  7#aj7 ,/ate  
,! t]m ,/ate means ea* ( ! #ej ,/ates1 !
 ,di/rict ( ,columbia1 ! ,commonweal? ( 
,pu]to ,rico1 ! ,unit$ ,/ates ,virg9    
,isl&s1 ,guam1 ,am]ican ,samoa1 & !     
,nor!rn ,m>iana ,isl&s4  7#aa7 ,univ]sal
 mobility s]vice ,! t]m univ]sal        
mobility s]vice means a s+le plat=m     
?r\gh :i* p ) disabilities or old]      
adults are able to-- 7,a7 access a      
v>iety ( public & private dem&          

responsive & fix$-r\te transportation   
s]vices :i* h ! necess>y vehicles &     
facilities to meet ! ne$s ( all us]s1   
reg>dless ( income1 geographic location1
 disability1 or age2  7,b7 & id5tify _! 
travel options & comp>e ! co/ & l5g? (  
trips us+ ea* su* option2 &  7,c7 s*$ule
 a ride1 monitor progress1 & pay = !    
trip1 reg>dless ( ! numb] ( transf]s &  
indep5d5t provid]s us$4  7b7 ,plann+    
grants  7#a7 ,9 g5]al ,n lat] ?an       
,janu>y #a ( ea* ( cal5d> ye>s #bjba    
?r\gh #bjbd1 f ! am\nt appropriat$ "u   
p>agraph 7#e71 ! ,secret>y %all1 subject
 to p>agraph 7#b71 aw>d plann+ grants to
 any ,/ate t applies = su* a grant = !  
purpose ( develop+ proposals = an ,,hcbs
 infra/ructure program4  7#b7           
,selection1 duration1 & numb] ( ,/ates  
7,a7 ,selection crit]ia ,9 aw>d+ grants 
= a ye> "u ?is subsection ! ,secret>y   
%all-- 7i7 consid] ! te*nical m]its !   
propos$ ,,hcbs infra/ructure program (  
ea* ,/ate t is apply+ = a grant 9 su*   
ye>2 &  7ii7 select a gr\p ( ,/ates t is

 div]se 9 t]ms (-- 7,i7 ! geographic    
areas ! gr\p repres5ts2  7,,ii7 !       
population sizes ( ! ,/ates compris+ !  
gr\p2 &  7,,iii7 ! subp>agraphs (       
subsection 7e77#b7 9 :i* ea* su* ,/ate  
is describ$ 7bas$ on data f ! #b mo/    
rec5t ye>s = :i* data is available74    
7,b7 ,duration ,grants aw>d$ "u ?is     
subsection %all be available to ,/ates =
 a p]iod ( #a ye>4  7,c7 ,numb] ( ,/ates
 ,! ,secret>y %all n aw>d plann+ grants 
"u ?is subsection to m ?an #ag ,/ates 9 
any ye>1 & no ,/ate may receive m ?an #a
 grant "u ?is subsection4  7#c7 ,use (  
funds ,a ,/ate aw>d$ a plann+ grant "u  
?is subsection %all-- 7,a7 e/abli% a    
,developm5t & ,implem5tation ,c\ncil t  
meets ! requirem5ts describ$ 9 p>agraph 
7#d7 to provide input into ! developm5t 
( ! proposal &1 if ! ,/ate receives     
approval to conduct a demon/ration      
program "u ?is section1 to monitor !    
ongo+ implem5tation ( ! program2  7,b7 )
 guidance f ! ,c5t]s = ,m$ic>e  ,m$icaid
 ,s]vices1 id5tify populations 9 ! ,/ate

 = :i* ! p] capita annual exp5ditures "u
 ! ,/ate plan or waiv] ( su* plan on    
home & community-bas$ s]vices is less   
?an ! national av]age = t population2   
7,c7 e/abli% a set ( /&>ds & proc$ures  
to ensure ! ,/ate makes measurable      
progress 9 exp&+ ! availability (       
self-direction to p s]v$ by home &      
community-bas$ s]vice provid]s2  7,d7   
develop a plan to increase home &       
community-bas$ s]vices1 increase !      
availability ( provid]s ( su* s]vice    
?r\gh\t ! ,/ate1 & address at lea/ #c ( 
! ,,hcbs infra/ructure priority areas   
describ$ 9 subsection 7c77#c72  7,e7    
solicit public comm5t to help det]m9e   
:at ! priorities ( ! propos$            
demon/ration program %\ld be2 &  7,f7   
execute memor&a ( und]/&+ betwe5 any    
,/ate ag5cies t w be responsible =      
activities "u ! propos$ demon/ration    
program "u :i* ea* su* ag5cy agrees to  
conduct ! activities = :i* x w be       
responsible & to coop]ate ) o!r ag5cies 
z necess>y4  7#d7 ,developm5t &         

,implem5tation ,c\ncil ,requirem5ts ,!  
requirem5ts describ$ 9 ?is p>agraph )   
respect to a ,developm5t &              
,implem5tation ,c\ncil e/abli%$ by a    
,/ate 7ref]r$ to 9 ?is section z a      
,c\ncil7 are ! foll[+3 7,a7 ,! memb]s ( 
! ,c\ncil 7! majority ( :om %all be p ) 
disabilities or old] adults :o ne$ home 
& community-bas$ s]vices7 %all consi/   
(-- 7i7 p ) disabilities or old] adults 
:o receive home & community-bas$        
s]vices2  7ii7 p ) disabilities1 includ+
 old] adults ) disabilities1 :o meet    
crit]ia = home & community-bas$ s]vices 
b are n receiv+ su* s]vices2  7iii7     
family c>egiv]s2  7iv7 direct support   
pr(essionals2  7v7 provid]s ( home &    
community-bas$ s]vices2  7vi7 "o        
repres5tative ea* f-- 7,i7 an           
organization t repres5ts p )            
disabilities2  7,,ii7 an organization t 
repres5ts old] adults2 &  7,,iii7 an    
organization t repres5ts direct support 
pr(essionals2 &  7vii7 repres5tatives f 
,/ate ag5cies t provide ag+1 disability1

 transportation1 h\s+1 employm5t1       
vocational rehabilitation1 m5tal heal?1 
& sub/ance use s]vices & repres5tatives1
 z appropriate1 f programs provid+      
transportation supports1 h\s+ supports1 
home & community-bas$ s]vices work=ce   
developm5t1 family c>egiv] supports1 &  
education & vocational rehabilitation   
s]vices4  7,b7 ,! ,c\ncil is coord9at$  
by ! ,gov]nor1 & any proposal ( !       
,c\ncil %all be submitt$ to1 & review$  
by1 by ! ,gov]nor be=e x is submitt$ to 
! ,secret>y4  7,c7 ,! ,c\ncil %all      
conduct a public comm5t process to      
collect in=mation to in=m ! priorities &
 activities id5tifi$ 9 ! grant          
application4  7#e7 ,fund+  7,a7 ,9 g5]al
 ,out ( any funds 9 ! ,treasury n       
o!rwise appropriat$1 !re is appropriat$ 
to ! ,secret>y = ea* ( fiscal ye>s #bjba
 ?r\gh #bjbd #ajj1jjj1jjj = purposes (  
aw>d+ grants "u ?is subsection4  7,b7   
,availability ,funds appropriat$ "u     
subp>agraph 7,a7 %all rema9 available   
until exp5d$4  7,c7 ,te*nical assi/ance 

7i7 ,9 g5]al ,= ea* ( fiscal ye>s #bjba 
?r\gh #bjbd1 out ( ! funds appropriat$ =
 su* ye> "u subp>agraph 7,a71 #c1jjj1jjj
 %all be res]v$ = ! purpose ( provid+   
te*nical assi/ance 7?r\gh ! ,adm9i/rator
 ( ! ,c5t]s = ,m$ic>e  ,m$icaid         
,s]vices7 to ,/ates 9 meet+ !           
requirem5ts ( p>agraph 7#b74  7ii7      
,coord9ation ) relevant ag5cies ,9      
provid+ te*nical assi/ance to ,/ates 9  
develop+ plans to improve ,,hcbs        
infra/ructure priority areas describ$ 9 
subsection 7c77#c71 ! ,adm9i/rator ( !  
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices %all
 consult ) o!r ag5cies ) relevant       
exp]tise 9 su* areas1 su* z ! ,dep>tm5t 
( ,transportation1 ! ,dep>tm5t ( ,h\s+ &
 ,urban ,developm5t1 & ! ,int]ag5cy     
,transportation ,coord9at+ ,c\ncil on   
,access & ,mobility e/abli%$ "u         
,executive ,ord] ,no4 #acccj4  7c7      
,,hcbs infra/ructure implem5tation      
grants  7#a7 ,approval ( ,/ates ,n lat] 
?an #a ye> aft] aw>d+ a plann+ grant to 
a ,/ate "u subsection 7b71 ! ,secret>y  

%all1 subject to p>agraph 7#d71 aw>d to 
! ,/ate an ,,hcbs infra/ructure         
implem5tation grant "u ?is section if ! 
application-- 7,a7 is develop$ ?r\gh su*
 plann+ grant2 &  7,b7 meets !          
requirem5ts ( p>agraph 7#b74  7#b7      
,grant requirem5ts ,! requirem5ts ( ?is 
p>agraph ) respect to a ,/ate           
implem5tation grant are ! foll[+3 7,a7  
,application ,! ,/ate submits an        
application1 us+ ! mo/ rec5t data       
available at ! "t ! ,/ate 0 aw>d$ a     
plann+ grant "u subsection 7b71 to      
conduct an ,,hcbs infra/ructure         
implem5tation grant to ! ,secret>y t    
includes1 9 addition to su* o!r         
in=mation z ! ,secret>y may require--   
7i7 t>gets = sp5d+ "u ! ,/ate plan or   
waiv] = home & community-bas$ s]vices "u
 ! ,/ate plan or waiv] z a p]c5tage (   
all sp5d+ "u ! plan or waiv] on long-t]m
 s]vices & supports1 & ye>ly mile/ones =
 su* t>gets t-- 7,i7 provide ,/ates ) ! 
flexibility to focus on provid+ home &  
community-bas$ s]vices to c]ta9         

populations2 &  7,,ii7 require ! ,/ate--
 7aa7 to a*ieve sp5d+ t>gets = ^?       
populations2  7bb7 to id5tify           
populations 9 ! ,/ate = :i* ! p] capita 
annual exp5ditures "u ! ,/ate plan or   
waiv] on home & community-bas$ s]vices  
is less ?an ! national av]age = t       
population2 &  7cc7 to increase ! level 
( exp5ditures on home & community-bas$  
s]vices = ea* population describ$ 9     
clause 7v77,,ii7 to a t>get level       
propos$ by ! ,/ate2  7ii7 a description 
( h[ ! ,/ate w-- 7,i7 exp& m$ical       
assi/ance = home & community-bas$       
s]vices "u ! plan or waiv] dur+ ! ,,hcbs
 infra/ructure p]iod2  7,,ii7 a*ieve !  
sp5d+ t>gets & mile/ones describ$ 9     
clause 7i72 &  7,,iii7 initiate or exp& 
self-direct$ s]vices1 ) measurable      
t>gets & mile/ones2  7iii7 if ! ,/ate   
limits ! provision ( home &             
community-bas$ s]vices to p "u ! plan or
 waiv] or imposes any num]ical          
limitation1 wait+ li/1 or simil>        
limitation on ! eligibility ( p = su*   

s]vices1 a detail$ plan = h[ ! ,/ate w  
r$uce su* limitations2  7iv7 a detail$  
plan ) measurable objectives & annual   
mile/ones = at lea/ #c ( ! ,,hcbs       
infra/ructure priority areas describ$ 9 
p>agraph 7#c72 &  7v7 data on ! ext5t to
 :i* ! ,/ate has already balanc$ !      
long-t]m s]vices & supports sy/em ( !   
,/ate1 includ+-- 7,i7 ! p]c5tage ( total
 annual exp5ditures "u ! ,/ate plan or  
waiv] = long-t]m s]vices & supports     
exp5ditures t are = home &              
community-bas$ s]vices2 &  7,,ii7 !     
p]c5tage ( total annual exp5ditures "u !
 ,/ate plan or waiv] = long-t]m s]vices 
& supports exp5ditures t are = home &   
community-bas$ s]vices by population    
gr\p1 includ+-- 7aa7 p ) intellectual & 
developm5tal disabilities2  7bb7 p ag$  
#fe & old]2  7cc7 p ) physical          
disabilities2 &  7dd7 p ) m5tal heal? & 
sub/ance use disord]s4  7,b7 ,ma9t5ance 
( eligibility requirem5ts ,dur+ ! ,,hcbs
 infra/ructure p]iod1 ! ,/ate does n    
apply eligibility /&>ds1 me?odologies1  

or proc$ures = det]m9+ eligibility =    
m$ical assi/ance = home & community-bas$
 s]vices "u ! plan or waiv] t are m     
re/rictive ?an ! eligibility /&>ds1     
me?odologies1 or proc$ures 9 effect =   
su* purposes on ,decemb] #ca1 #bjai4    
7,c7 ,implem5tation & compliance )      
,,hcbs ,sett+s ,rule ,! ,/ate has a f9al
 approv$ plan to-- 7i7 fully comply ) ! 
,home & ,community-,bas$ ,s]vices ,f9al 
,rule publi%$ by ! ,c5t]s = ,m$ic>e     
,m$icaid ,s]vices on ,janu>y #af1 #bjad 
7#gi ,f$4 ,reg4 #bidg7 7ref]r$ to 9 ?is 
section z ! ,,hcbs ,sett+s ,rule72 &    
7ii7 con/ruct ! activities ( ! grant su*
 t ! results w be to /abilize & exp& !  
s]vice deliv]y network available 9 !    
,/ate to provide s]vices & supports "u !
 ,/ate plan or waiv] ( su* plan 9 a     
mann] t complies ) ! ,,hcbs ,sett+s     
,rule4  7,d7 ,use ( additional funds ,! 
,/ate uses any additional ,f$]al funds  
paid to ! ,/ate z a result ( ?is section
 only = purposes ( increas+ !           
availability & improv+ ! quality ( home 

& community-bas$ s]vices 9 ! ,/ate4     
7,e7 ,data collection ,! ,/ate collects 
/&>diz$ data z det]m9$ by ! ,secret>y1  
includ+-- 7i7 s]vices data on a         
p]-capita or family c>egiv] basis &1 to 
! ext5t possible1 9 accordance ) !      
,trans=m$ ,m$icaid ,/ati/ical ,in=mation
 ,sy/em 7,t-,,msis7 7or a successor     
sy/em72  7ii7 quality data on a select$ 
set ( core home & community-bas$ s]vices
 measures det]m9$ by ! ,secret>y1       
includ+-- 7,i7 measures ( b5efici>y &   
family c>egiv] exp]i5ce2  7,,ii7        
measures = ! a*ievem5t ( desir$ outcomes
 appropriate to a specific b5efici>y or 
family c>egiv]1 includ+-- 7aa7 community
 inclusion2  7bb7 *oice & p]sonal       
control1 includ+ ?r\gh self-direct$     
s]vices2 &  7cc7 p]son-c5t]$ plann+2 &  
7,,iii7 measures = ! a*ievem5t ( home & 
community-bas$ s]vices infra/ructure    
improvem5ts1 includ+-- 7aa7 competitive1
 integrat$ employm5t = p ) disabilities 
& old] adults2  7bb7 direct support     
pr(essional work=ce improvem5ts1 includ+

 increas$ wages2  7cc7 c>egiv] supports2
  7dd7 accessible h\s+ & accessible     
transportation improvem5ts2 &  7ee7     
non-disability-specific sett+s2  7iii7  
s]vices data f provid]s ( home &        
community-bas$ s]vices on a p]-b5efici>y
 or family c>egiv] basis & 9 accordance 
) su* /&>diz$ cod+ proc$ures z ! ,/ate  
%all e/abli% 9 consultation ) !         
,secret>y2  7iv7 quality data on a      
select$ set ( core quality measures     
agre$ ^u by ! ,secret>y & ! ,/ate t     
are-- 7,i7 l9k$ to population-specific  
outcomes measures2 &  7,,ii7 available  
to ! public1 includ+ consum]s & provid]s
 ( home & community-bas$ s]vices2 &  7v7
 outcomes measures data on a select$ set
 ( core population-specific outcomes    
measures agre$ ^u by ! ,secret>y & !    
,/ate t are accessible to provid]s &    
include-- 7,i7 measures ( b5efici>y &   
family c>egiv] exp]i5ce ) provid]s2 &   
7,,ii7 measures = a*iev+ desir$ outcomes
 appropriate to a specific b5efici>y or 
family c>egiv]1 includ+-- 7aa7          

competitive integrat$ employm5t 7z def9$
 9 section #c7aa7 ( ! ,work=ce          
,innovation & ,opportunity ,act72  7bb7 
p>ticipation 9 community life2  7cc7    
heal? /ability2  7dd7 prev5tion ( loss 9
 function2 &  7ee7 improv$ family       
c>egiv] heal? & wellness4  7#c7 ,,hcbs  
infra/ructure priority areas ,! ,,hcbs  
infra/ructure priority areas describ$ 9 
?is p>agraph are ! foll[+3 7,a7 ,work=ce
 & unpaid c>egiv] supports ,! ,/ate     
develops & implem5ts1 9 consultation )  
repres5tatives ( p ) disabilities1      
repres5tatives ( old] adults1 &         
repres5tatives ( direct support work]s--
 7i7 infra/ructure to enhance supply &  
ret5tion ( ! direct support work=ce1    
includ+ ?r\gh-- 7,i7 enhancem5t ( paym5t
 rates1 cont+5t on wage increases =     
direct support pr(essionals2 &  7,,ii7  
tra9+ & c>e] advancem5t programs =      
direct support pr(essionals1 includ+    
programs t facilitate ! p>ticipation (  
direct support pr(essionals 9           
organizations t fo/] _! pr(essional     

developm5t & /akehold] engagem5t2  7ii7 
infra/ructure to support self-direction1
 includ+-- 7,i7 mat*+ s]vice regi/ries2 
&  7,,ii7 tra9+ = consum]s :o want to   
self-direct2 &  7iii7 supports = family 
c>egiv]s1 includ+-- 7,i7 use ( family   
c>egiv] assessm5ts2  7,,ii7 s]vice (f]+s
 t support c>egiv]s & may delay or      
ameliorate ! ne$ = m compreh5sive       
non-in/itutional long-t]m s]vices &     
supports2 &  7,,iii7 implem5tation (    
evid5ce-bas$ c>egiv] supportive s]vices1
 increas$ access to & improvem5ts 9     
respite c>e1 & f9ancial assi/ance to    
help ) out-(-pocket co/s incurr$ by     
family c>egiv]s4  7,b7 ,employm5t       
supports ,! ,/ate develops & implem5ts  
/atewide infra/ructure1 subject to !    
m]it-bas$ p]sonnel /&>ds & conflict (   
int]e/ safegu>ds e/abli%$ & ma9ta9$ by !
 ,/ate pursuant to section              
#aijb7;a77#d71 to support opportunities 
= competitive integrat$ employm5t 7z    
def9$ 9 section #c7aa7 ( ! ,work=ce     
,innovation & ,opportunity ,act7 = p )  

disabilities & old] adults1 :i* may     
include-- 7i7 s]vice deliv]y            
modifications & expansion2 &  7ii7      
e/abli%+ & exp&+ l9kages ) o!r programs 
t support work]s ) disabilities1 su* z--
 7,i7 vocational rehabilitation2  7,,ii7
 "o-/op c5t]s describ$ 9 section #aba ( 
! ,work=ce ,innovation & ,opportunity   
,act2 &  7,,iii7 ,/ate dep>tm5ts (      
education4  7,c7 ,h\s+ supports ,! ,/ate
 develops & implem5ts infra/ructure to  
increase ! availability ( af=dable1     
accessible h\s+ 9                       
non-disability-specific sett+s = p )    
disabilities & old] adults receiv+ home 
& community-bas$ s]vices1 :i* may       
include-- 7i7 assess+ ! supply &        
availability ( su* h\s+ 9 communities   
across ! ,/ate2  7ii7 creat+ or scal+   
inc5tives = ,/ate & local h\s+ p>tn]s & 
develop]s to create m accessible h\s+2  
7iii7 develop+ & implem5t+ /rategies to 
t>get p ) ! mo/ significant developm5tal
 & o!r disabilities1 includ+ p ) *all5g+
 behavior1 complex m$ical ne$s1 p       

requir+ r\nd-!-clock1 "o-on-"o support f
 a direct support pr(essional1 & p ) v  
high-s]vice ne$s1 = h\s+ 9              
non-disability-specific sett+s2  7iv7   
scal+ %>$ liv+ )9 ! ,/ate2  7v7 home    
modifications & repairs t make x        
possible = a p]son to rema9 9 ! p]son's 
home or build+ modifications t make x   
possible = a p]son ) a disability or an 
old] adult to reside 9 a h\se or        
ap>tm5t2 &  7vi7 develop+ adm9i/rative  
infra/ructure to mat* p ) h\s+ & provide
 mean+ful *oices among                  
non-disability-specific sett+s via !    
p]son-c5t]$ plann+ process4  7,d7       
,transportation supports  7i7 ,9 g5]al  
,! ,/ate develops & implem5ts /rategies 
to improve access = all p ) disabilities
 & old] adults 7includ+ p :o are bl9d or
 visually impair$1 deaf or h>d ( he>+1 h
 o!r physical disabilities1 use a       
:eel*air or o!r mobility device1 use a  
guide animal1 or h an intellectual      
disability7 to accessible transportation
 options1 includ+ fir/ mile_/la/ mile   

transportation1 ) ! goal ( improv$      
community integration1 9 accordance ) ! 
,,hcbs ,sett+ ,rule1 :i* may include--  
7,i7 ! provision ( univ]sal mobility    
s]vices 7z def9$ 9 subsection 7a77#aa772
  7,,ii7 p>tn]+ ) exi/+ non-em]g5cy     
m$ical transportation brok]s & _!       
networks2  7,,iii7 p>tn]+ )             
dem&-responsive provid]s1               
non-disability-specific non-pr(it       
provid]s1 & o!r transportation provid]s2
  7,,iv7 ! t>get$ developm5t ( a        
community integration transportation    
sy/em t lev]ages traditional &          
innovative transportation networks 7su* 
z on-dem& application-bas$              
transportation72 &  7,v7 exp&+ !        
non-em]g5cy m$ical transportation       
s]vices (f]$ "u ! ,/ate plan to include 
transportation to-- 7aa7 employm5t tra9+
 & jobs2  7bb7 community-bas$ supportive
 s]vices su* z congregate meals or      
indep5d5t liv+ c5t]s2 &  7cc7 ph>macies1
 groc]y /ores1 & o!r retail e/abli%m5ts 
to assi/ old] adults & p ) disabilities 

to rema9 9 _! homes & p>ticipate fully 9
 _! communities4  7ii7 ,tra9+ requirem5t
 ,any /rategy to improve access to      
transportation "u ?is subp>agraph %all  
include ! implem5tation ( a ,/ate       
requirem5t t provid]s ( transportation  
receive tra9+ on h[ to support p )      
disabilities & old] adults4  7iii7      
,exclusion ,to ! ext5t t any expansion1 
developm5t1 or f9anc+ ( p>atransit is   
requir$ "u ! ,am]icans ) ,disabilities  
,act = fix$ r\te s]vice1 su* expansion1 
developm5t1 or f9anc+ %all n be consid]$
 to be a /rategy to improve access to   
transportation = purposes ( ?is         
subp>agraph4  7iv7 ,consid]ation (      
,national ,ag+ & ,disability            
,transportation ,c5t] proposals ,a      
proposal = improvem5ts describ$ 9 ?is   
subp>agraph %all consid] & discuss ! "w 
( ! ,national ,ag+ & ,disability        
,transportation ,c5t]1 ! ,transactional 
,data ,specification = ,dem& ,responsive
 ,transportation publi%$ by !           
,transportation ,rese>* ,bo>d1 & be/    

practices = ! deliv]y ( ,m$icaid        
non-em]g5cy m$ical transportation       
s]vices4  7,e7 ,no wrong door s+le entry
 po9t sy/em ,! ,/ate develops &         
implem5ts a /atewide sy/em 7:i* may     
include preadmission scre5+ by nurses1  
pe] assessors1 & o!r necess>y provid]s  
to ensure t ! appropriate assessm5ts )  
respect to any p]son ) a disability or  
old] adult are done z soon z requir$71  
subject to ! m]it-bas$ p]sonnel /&>ds & 
conflict ( int]e/ safegu>ds e/abli%$ &  
ma9ta9$ by ! ,/ate pursuant to section  
#aijb7;a77#d71 to enable p enroll$ 9 !  
,/ate plan or waiv] to access1 on a     
timely basis1 all long-t]m s]vices &    
supports ?r\gh an ag5cy1 organization1  
coord9at$ network1 or portal1 9         
accordance ) su* /&>ds z ! ,/ate %all   
e/abli% & t %all provide in=mation      
reg>d+-- 7i7 ! availability ( su*       
s]vices2  7ii7 h[ to apply = su*        
s]vices2  7iii7 disability b5efits      
c\nsel+2  7iv7 ref]ral s]vices = s]vices
 & supports o!rwise available 9 !       

community2 &  7v7 det]m9ations (        
f9ancial & functional eligibility = su* 
s]vices & supports1 or assi/ance )      
assessm5t processes = f9ancial &        
functional eligibility4  7#d7 ,numb] (  
,/ates ,! ,secret>y %all n grant        
approval to m ?an #ag ,/ates to conduct 
an ,,hcbs infra/ructure demon/ration    
program "u ?is section 9 any ye>4  7d7  
,evaluation1 ov]sight1 & quality  7#a7  
,surveys & report on direct support     
pr(essional comp5sation  7,a7 ,9 g5]al  
,ea* ,,hcbs infra/ructure ,/ate %all1 = 
ea* fiscal ye> ( ! ,/ate's ,,hcbs       
infra/ructure p]iod1 conduct surveys (  
provid]s t receiv$ increas$ rates "u !  
,,hcbs infra/ructure program conduct$ by
 ! ,/ate on ! comp5sation paid by su*   
provid]s to direct support pr(essionals4
  7,b7 ,report ,n lat] ?an #b ye>s aft] 
! date t an ,,hcbs infra/ructure ,/ate  
beg9s to conduct an ,,hcbs infra/ructure
 program1 ! ,/ate submits a report to ! 
,adm9i/rator ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices on ! impact ( ! rate  

increases on ! comp5sation1 b5efits1 &  
tra9+ receiv$ by direct support         
pr(essionals4  7#b7 ,evaluation  7,a7 ,9
 g5]al ,! ,secret>y %all evaluate !     
implem5tation & outcomes ( ! ,,hcbs     
infra/ructure programs conduct$ by !    
,/ates 9 ! aggregate us+ an ext]nal     
evaluator ) exp]i5ce evaluat+ home &    
community-bas$ s]vices1 disability      
programs1 & old] adult programs us+ !   
crit]ia describ$ 9 ea* ,,hcbs           
infra/ructure ,/ate's application &     
evaluat+ any *ange 9 ,,hcbs s]vice      
availability & quality = ea* ,,hcbs     
infra/ructure ,/ate4  7,b7 ,evaluation  
crit]ia ,! ext]nal evaluator %all       
docum5t & evaluate *anges 9 access1     
availability1 & quality ( ,,hcbs s]vices
 9 ea* ( ! priority areas describ$ 9    
subsection 7c77#c7 *os5 by ea* ,,hcbs   
infra/ructure ,/ate4 ,! ext]nal         
evaluator %all also evaluate ! aggregate
 *ange *anges 9 access1 availability1 & 
quality ( ,,hcbs s]vices 9 ea* ( !      
priorities areas describ$ 9 subsection  

7c77#c7 across ! ,,hcbs infra/ructure   
,/ates4 ,! ext]nal evaluator %all also  
evaluate ! ,,hcbs infra/ructure programs
 bas$ on 7i7 ! impact ( ! programs on   
increas+ fund+ = home & community-bas$  
s]vices1 7ii7 ! impact ( ! programs on  
a*iev+ t>get$ access1 availability1 &   
quality ( home & community-bas$ s]vices1
 & 7iii7 promis+ practices id5tifi$ by !
 programs t increase access to1         
availability (1 & quality ( home &      
community bas$ s]vices4  7,c7           
,dissem9ation ( evaluation f9d+s ,!     
,secret>y %all-- 7i7 dissem9ate ! f9d+s 
f ! evaluations ( ,,hcbs infra/ructure  
programs conduct$ "u ?is p>agraph to--  
7,i7 all ,/ate ,m$icaid directors2 &    
7,,ii7 ! ,committees on ,ways & ,means &
 ,en]gy & ,comm]ce ( ! ,h\se (          
,repres5tatives1 ! ,committee on ,f9ance
 ( ! ,s5ate1 & ! ,special ,committee on 
,ag+ ( ! ,s5ate2 &  7ii7 make all       
evaluation f9d+s publicly available 9 an
 accessible electronic =mat & any o!r   
accessible =mat det]m9$ appropriate by !

 ,secret>y4  7,d7 ,ov]sight ,ea* ,/ate  
aw>d$ a grant "u subsection 7c7 %all    
ensure adequate ov]sight ( ! exp5diture 
( ,,hcbs infra/ructure program grant    
funds 9 accordance ) ! ,m$icaid         
regulations1 includ+ waiv] #aaae & #aiae
 waiv] regulations4  7e7 ,f9anc+        
inc5tives  7#a7 ,9 g5]al ,not)/&+       
section #aije7;b71 ) respect to ea*     
fiscal ye> 9 an ,,hcbs infra/ructure    
,/ate's ,,hcbs infra/ructure p]iod1 if  
su* ,/ate meets ! conditions describ$ 9 
subsection 7c77#b7 = ! ye>1 ! ,f$]al    
m$ical assi/ance p]c5tage t w\ld o!rwise
 apply ) respect to eligible ,,hcbs     
exp5ditures made by ! ,/ate dur+ ! ye>  
%all be increas$ 7b 9 no case to exce$  
#ajj p]c5t7 by ! applicable p]c5tage    
po9ts increase det]m9$ = ! ,/ate & ye>  
"u p>agraph 7#b7 7& z increas$1 if      
applicable1 "u p>agraph 7#c774  7#b7    
,applicable p]c5tage po9ts increase ,!  
applicable p]c5tage po9ts increase = an 
,,hcbs infra/ructure ,/ate & ye> is--   
7,a7 9 ! case ( a ,/ate 9 :i*1 = ! #b   

ye>s prec$+ ! ye> involv$1 less ?an #ce 
p]c5t ( ! total exp5ditures = long-t]m  
s]vices & supports 7 = home &           
community-bas$ s]vices1 #e p]c5tage     
po9ts2  7,b7 9 ! case ( a ,/ate 9 :i*1 =
 ! #b ye>s prec$+ ! ye> involv$1 betwe5 
#ce p]c5t & #ej p]c5t ( ! total         
exp5ditures = long-t]m s]vices &        
supports 7 = home & community-bas$      
s]vices1 #b p]c5tage po9ts2  7,c7 9 !   
case ( a ,/ate 9 :i*1 = ! #b ye>s prec$+
 ! ye> involv$1 betwe5 #ej p]c5t & #fe  
p]c5t ( ! total exp5ditures = long-t]m  
s]vices & supports 7 = home &           
community-bas$ s]vices1 #j4ej p]c5tage  
po9ts2 &  7,d7 9 ! case ( a ,/ate 9 :i*1
 = ! #b ye>s prec$+ ! ye> involv$1 #fe  
p]c5t or m ( ! total exp5ditures =      
long-t]m s]vices & supports 7 = home &  
community-bas$ s]vices1 #j4be p]c5tage  
po9ts4  7#c7 ,additional increase to    
inc5tivize t>get+ und]s]v$ populations  
,beg9n+ ) ! fir/ full fiscal ye> = :i* !
 ,trans=m$ ,m$icaid ,/ati/ical          
,in=mation ,sy/em 7,t-,,msis7 is fully  

op]ational1 ! applicable p]c5tage po9ts 
increase det]m9$ = an ,,hcbs            
infra/ructure ,/ate & ye> "u p>agraph   
7#b7 %all be increas$ by an additional--
 7,a7 9 ! case ( a ,/ate t is provid+   
home & community bas$ s]vices to #he    
p]c5t or m ( ! p t make up ! populations
 id5tifi$ by ! ,/ate "u subsection      
7b77#c77;,b71 #e p]c5tage po9ts2  7,b7 9
 ! case ( a ,/ate t is provid+ home &   
community bas$ s]vices to betwe5 #ge    
p]c5t & #he p]c5t ( ! p t make up !     
populations id5tifi$ by ! ,/ate "u      
subsection 7b77#c77;,b71 #b p]c5tage    
po9ts2  7,c7 9 ! case ( a ,/ate t is    
provid+ home & community bas$ s]vices to
 betwe5 #fe p]c5t & #ge p]c5t ( ! p t   
make up ! populations id5tifi$ by !     
,/ate "u subsection 7b77#c77;,b71 #j4e  
p]c5tage po9ts2 &  7,d7 9 ! case ( a    
,/ate t is provid+ home & community bas$
 s]vices to less ?an #fe p]c5t ( ! p t  
make up ! populations id5tifi$ by !     
,/ate "u subsection 7b77#c77;,b71 #j4be 
p]c5tage po9ts4  7#d7 ,exemption f      

limits on paym5ts to t]ritories ,!      
limitations on paym5t "u subsections 7f7
 & 7g7 ( section #aajh %all n apply to  
,f$]al paym5ts "u ?is title t are bas$  
on ! ,f$]al m$ical assi/ance p]c5tage z 
increas$ "u ?is subsection1 & su*       
paym5ts %all n be tak5 into acc\nt 9    
apply+ su* subsections4  4